The Choice! The challenges of trying to improve medical students’ satisfaction with their specialty choices

Authors

  • Melinda Davis University of Calgary
  • Janeve Desy University of Calgary
  • Aliya Kassam University of Calgary
  • Kevin Mclaughlin University of Calgary https://orcid.org/0000-0002-3092-5325

DOI:

https://doi.org/10.36834/cmej.73643

Abstract

The authors describe the residency match as a two-step process. The first step, the Choice, is where students use a combination of intuitive and analytic information processing to select the specialty that they believe will provide fulfilment and work-life balance over their entire career. The second step, the Match, uses a “deferred-acceptance” algorithm to optimize pairing of students and their specialty choices. Despite being the rate-limiting step, in the minds of students and other stakeholders, the outcomes of the Choice have typically been eclipsed by the outcomes of the Match. A recently published study found that during their second year of residency training, one in 14 physicians reported specialty choice regret, which associates with symptoms of burnout in residents. While the obvious solution is to design interventions that improve the specialty choices of students, this approach faces significant challenges, including the fact that: 1) satisfaction with specialty choice is a difficult-to-define construct; 2) specialty choice regret may be misattributed to a poor choice; and 3) choosing is a more complicated process than matching. The authors end by suggesting that if we hope to improve satisfaction with specialty choice then we should begin by defining this, deciding when to assess it, and then creating assessment tools for which there is validity evidence and that can identify the underlying causes of specialty choice regret. 

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References

Roth AE. The origins, history, and design of the resident match. JAMA 2003;289:909-12. https://doi.org/10.1001/jama.289.7.909 DOI: https://doi.org/10.1001/jama.289.7.909

Gale D, Shapley, L. College admissions and the stability of marriage. Am Math Mon 1962;69 9-15. https://doi.org/10.1080/00029890.1962.11989827 DOI: https://doi.org/10.1080/00029890.1962.11989827

Hill MR, Goicochea, S., Merlo, L.J. In their own words: stressors facing medical students in the mellennial generation. Med Educ Online 2017;23:1530558. https://doi.org/10.1080/10872981.2018.1530558 DOI: https://doi.org/10.1080/10872981.2018.1530558

Wilson CR, Bordman ZN. What to do about the Canadian Resident Matching Service. CMAJ 2017;189:E1436-E47. https://doi.org/10.1503/cmaj.170791 DOI: https://doi.org/10.1503/cmaj.170791

Nagarkar PA, Janis JE. Fixing the "match": how to play the game. J Grad Med Educ 2012;4:142-7. https://doi.org/10.4300/JGME-D-11-00292.1 DOI: https://doi.org/10.4300/JGME-D-11-00292.1

Yang Y, Li J, Wu X, et al. Factors influencing subspecialty choice among medical students: a systematic review and meta-analysis. BMJ Open 2019;9:e022097. https://doi.org/10.1136/bmjopen-2018-022097 DOI: https://doi.org/10.1136/bmjopen-2018-022097

Canadian Residency Matching Service (CaRMS). 2020.

National Resident Matching Program, Results and Data: 2018 Main Residency Match®. Washington, DC.2018.

Dyrbye LN, Burke SE, Hardeman RR, et al. Association of clinical specialty with symptoms of burnout and career choice regret among US resident physicians. JAMA 2018;320:1114-30. https://doi.org/10.1001/jama.2018.12615 DOI: https://doi.org/10.1001/jama.2018.12615

Okoniewska BL, M.A.; Ma, I.W.Y. Journey of candidates who were unmatched in the Canadian Residency Matching Service (CaRMS): a phenomenological study. CMEJ 2020. https://doi.org/10.36834/cmej.69318 DOI: https://doi.org/10.36834/cmej.69318

Dyrbye LN, Varkey P, Boone SL, Satele DV, Sloan JA, Shanafelt TD. Physician satisfaction and burnout at different career stages. Mayo Clin Proc 2013;88:1358-67. https://doi.org/10.1016/j.mayocp.2013.07.016 DOI: https://doi.org/10.1016/j.mayocp.2013.07.016

Kane MT. Validation. In: Brennan RL, ed. Educational measurement. 4th ed. Westport.: Praeger.; 2006:17-64.

Cook DA, Brydges R, Ginsburg S, Hatala R. A contemporary approach to validity arguments: a practical guide to Kane's framework. Med Educ 2015;49:560-75. https://doi.org/10.1111/medu.12678 DOI: https://doi.org/10.1111/medu.12678

Cook DA, Kuper A, Hatala R, Ginsburg S. When assessment data are words: validity evidence for qualitative educational assessments. Acad Med 2016;91:1359-69. https://doi.org/10.1097/ACM.0000000000001175 DOI: https://doi.org/10.1097/ACM.0000000000001175

Diener E, Larsen RJ, Emmons RA. Person x situation interactions: choice of situations and congruence response models. J Pers Soc Psychol 1984;47:580-92. https://doi.org/10.1037/0022-3514.47.3.580 DOI: https://doi.org/10.1037/0022-3514.47.3.580

Furr RM, Funder, D. Persons, situations, and person-situation interactions. In: John OP, Robins, R.W. , ed. Handbook of Personality: Theory and Research 4th ed. New York: Guilford Press; 2018.

Rozin P, Royzman, E.B. Negativity bias, negativity dominance, and contagion. Pers Soc Psychol Rev 2001;5:296-320. https://doi.org/10.1207/S15327957PSPR0504_2 DOI: https://doi.org/10.1207/S15327957PSPR0504_2

Panagioti M, Geraghty K, Johnson J, et al. Association between physician burnout and patient safety, professionalism, and patient satisfaction: a systematic review and meta-analysis. JAMA Intern Med 2018;178:1317-31. https://doi.org/10.1001/jamainternmed.2018.3713 DOI: https://doi.org/10.1001/jamainternmed.2018.3713

Dijksterhuis A, Bos MW, Nordgren LF, van Baaren RB. On making the right choice: the deliberation-without-attention effect. Science 2006;311:1005-7. https://doi.org/10.1126/science.1121629 DOI: https://doi.org/10.1126/science.1121629

Sloman SA. The empirical case for two systems of reasoning. Psychol Bull 1996;119:3-22. https://doi.org/10.1037/0033-2909.119.1.3 DOI: https://doi.org/10.1037/0033-2909.119.1.3

Kahneman. Thinking, fast and slow. London2009.

Huntsinger JR, Sinclair S, Dunn E, Clore GL. Affective regulation of stereotype activation: it's the (accessible) thought that counts. Pers Soc Psychol Bull 2010;36:564-77. https://doi.org/10.1177/0146167210363404 DOI: https://doi.org/10.1177/0146167210363404

Simmons JP, LeBoeuf RA, Nelson LD. The effect of accuracy motivation on anchoring and adjustment: do people adjust from provided anchors? J Pers Soc Psychol 2010;99:917-32. https://doi.org/10.1037/a0021540 DOI: https://doi.org/10.1037/a0021540

Tversky A, Kahneman, D. Availability: a heuristic for judging frequency and probability. Cognitive Psychol 1973;5:207-32. https://doi.org/10.1016/0010-0285(73)90033-9 DOI: https://doi.org/10.1016/0010-0285(73)90033-9

Scott I, Wright B, Brett-MacLean P, Brenneis F. Career decision making in medical school: how medical students choose in the early years. Med Teach 2008;30:543. https://doi.org/10.1080/01421590701802307 DOI: https://doi.org/10.1080/01421590701802307

Kassebaum DG, Szenas PL. Medical students' career indecision and specialty rejection: roads not taken. Acad Med 1995;70:937-43. https://doi.org/10.1097/00001888-199510000-00018 DOI: https://doi.org/10.1097/00001888-199510000-00018

Scott I, Gowans MC, Wright B, Brenneis F. Why medical students switch careers: changing course during the preclinical years of medical school. Can Fam Physician 2007;53:95,:e1-5,4.

Scott I, Gowans M, Wright B, Brenneis F. Stability of medical student career interest: a prospective study. Acad Med 2012;87:1260-7. https://doi.org/10.1097/ACM.0b013e31826291fa DOI: https://doi.org/10.1097/ACM.0b013e31826291fa

Ladha FA, Pettinato AM, Perrin AE. Medical student residency preferences and motivational factors: a longitudinal, single-institution perspective. BMC Med Educ 2022;22:187. https://doi.org/10.1186/s12909-022-03244-7 DOI: https://doi.org/10.1186/s12909-022-03244-7

American Medical Association. Want to switch residency programs? 5 things you should know. Available at https://www.ama-assn.org/residents-students/residency/want-switch-residency-programs-5-things-you-should-know.

Resident Doctors of Canada. Resident transfers. Available at https://residentdoctors.ca/areas-of-focus/resident-transfers/.

Kumar B, Kanna B, Kumar S. The pitfalls of premature closure: clinical decision-making in a case of aortic dissection. BMJ Case Rep 2011;2011. https://doi.org/10.1136/bcr.08.2011.4594 DOI: https://doi.org/10.1136/bcr.08.2011.4594

Wang S, Krajbich I, Adolphs R, Tsuchiya N. The role of risk aversion in non-conscious decision making. Front Psychol 2012;3:50. https://doi.org/10.3389/fpsyg.2012.00050 DOI: https://doi.org/10.3389/fpsyg.2012.00050

Asch SE. The doctrine of suggestion, prestige and imitation in social psychology. Psychol Rev 1948;55:250-76. https://doi.org/10.1037/h0057270 DOI: https://doi.org/10.1037/h0057270

Polman E, Vohs, K. Decision fatigue, choosing for others, and self-construal. Soc Psychol Pers Sci 2016;7:471-8. https://doi.org/10.1177/1948550616639648 DOI: https://doi.org/10.1177/1948550616639648

Morewedge CK, Kahneman D. Associative processes in intuitive judgment. Trends Cogn Sci 2010;14:435-40. https://doi.org/10.1016/j.tics.2010.07.004 DOI: https://doi.org/10.1016/j.tics.2010.07.004

Waring JD, Kensinger EA. How emotion leads to selective memory: neuroimaging evidence. Neuropsychologia 2011;49:1831-42. https://doi.org/10.1016/j.neuropsychologia.2011.03.007 DOI: https://doi.org/10.1016/j.neuropsychologia.2011.03.007

de Kock FS, Hauptfleisch, D.B. Reducing racial similarity bias in interviews by increasing structure: a quasi-experiment using multilevel analysis. Int Perspect Psychol 2018;7:137-54. https://doi.org/10.1037/ipp0000091 DOI: https://doi.org/10.1037/ipp0000091

Prober CG. The match: to thine own self be true. Acad Med 2019;94:317-20. https://doi.org/10.1097/ACM.0000000000002557 DOI: https://doi.org/10.1097/ACM.0000000000002557

Beran T, Hecker K, Coderre S, Wright B, Woloschuk W, McLaughlin K. Ego identity status of medical students in clerkship. CMEJ. 2011;2:e4-e10. https://doi.org/10.36834/cmej.36558 DOI: https://doi.org/10.36834/cmej.36558

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Published

2023-08-11

How to Cite

1.
Davis M, Desy J, Kassam A, Mclaughlin K. The Choice! The challenges of trying to improve medical students’ satisfaction with their specialty choices. Can. Med. Ed. J [Internet]. 2023 Aug. 11 [cited 2024 Jul. 13];14(5):49-55. Available from: https://journalhosting.ucalgary.ca/index.php/cmej/article/view/73643

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Reviews, Theoretical Papers, and Meta-Analyses

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